In the News: 02/06
Large-Scale Glucosamine/Chondroitin Study Leaves Questions
Early results from the $14 million National Institutes of Health (NIH)-sponsored Glucosamine/Chondroitin Arthritis Intervention Trail (GAIT) show that while glucosamine/chondroitin may be effective in relieving the pain in people with moderate-to-severe knee osteoarthritis, the combination supplement failed to produce significant pain relief in patients with mild-to-moderate knee OA.
The GAIT study, the largest ever conducted in the U.S., included nearly 1,600 patients with knee OA. Patients received glucosamine hydrochloride (500mg three times a day), sodium chondroitin sulfate (400mg three times a day), both supplements, celecoxib, or a placebo. Those who took celecoxib reported more pain relief than patients on placebo. Among patients with mild-to-moderate pain, pain reduction from glucosamine and chondroitin was not statistically significant compared with those on placebo. Patients with moderate-to-severe knee pain, on the other hand, showed a 79.2 percent positive response rate.
According to some rheumatologists, the GAIT study suffered from three factors: Researchers used glucosamine hydrochloride (more positive studies in Europe have used glucosamine sulfate), the study included a majority of patients with mild-to-moderate symptoms (78 percent had only mild knee pain), and the dosing was three times a day rather than once a day (many physicians recommend higher once-a-day dosing, which provides a greater concentration to activate cells). Many physicians claim that since the risk of using the supplements is low and the cost minimal, there is enough evidence to suggest using them. The Arthritis Foundation supported this view by stating, “Based on this study and the supplements’ safety and cost-effectiveness, the combination of glucosamine and chondroitin should be considered as part of an overall treatment for knee OA.”
We will be studying the impact of the GAIT study closely and will report in detail on its findings, and fallout, in an upcoming issue. Another arm of the study, to be undertaken later this year, will assess the rate of X-ray progression of knee OA among glucosamine and chondroitin users.
Weight Loss Beats Drugs for OA Pain
Losing even a little weight can reduce pain, relieve stiffness, and increase function for people suffering from knee osteoarthritis. A recent study of 48 significantly overweight adults with knee OA—38 women with an average weight of 200 pounds, 10 men who weighed an average 225 pounds—showed that a 15-pound weight loss reduced pain by 40 percent, improved function by 50 percent, and reduced stiffness by 48 percent. Participants underwent a 16-week weight-loss program that included walking and weight-loss education. The findings compared favorably with a 28 percent improvement in function seen with drugs such as celecoxib and rofecoxib.
Among male participants, improvements were closely associated with percentage of weight loss, while among female participants pain and function scores were not directly associated with weight loss. Researchers speculated that, among women, the differences may be psychological—i.e. even slight weight loss may have helped them feel better. The study was presented at a recent meeting of the American College of Rheumatology.
Traction Is Not Beneficial for Lower Back Pain
Despite its widespread use, traction, which has been used for centuries to treat lower back pain, produces no benefit. A recent analysis of 24 studies involving 2,177 people with lower back pain found that neither continuous nor intermittent traction was more effective for pain relief than a placebo or other treatments. Patients were treated with various forms of traction, no treatment, other treatments, or a placebo for as little as two weeks to as long as one year. Researchers claim that although the potential side effects of traction are known—increased pain, neurological damage, the need for surgery—they have not been shown to be a deterrent to using traction. Other treatments for lower back pain include over-the-counter pain relievers, prescription drugs, physical therapy, and behavioral therapy. The study analysis appeared in a recent issue of The Cochrane Library, a publication that evaluates medical research.